Objective This randomized controlled trial aimed to compare the efficacy of negative-pressure wound therapy with advanced moist wound therapy in managing diabetic foot ulcers. Methods A total of 450 participants with diabetic foot ulcers were randomized to receive either negative-pressure wound therapy (n = 204) or advanced moist wound therapy (n = 246) over 18 months. The primary outcome was complete ulcer closure, with secondary outcomes including time to closure, wound size reduction, infection rates, recurrence, and amputation rates. Wound dimensions were measured using digital planimetry, and Kaplan-Meier survival analysis was applied to assess time to closure. Result Analysis revealed statistically significant differences in clinical outcomes between treatment modalities. In the negative-pressure wound therapy group (n = 204), complete ulcer closure was achieved in 177 patients (87%), which was significantly greater than the advanced moist wound therapy group (n = 246) with 72 patients (29%) (P < .001). Although the mean time to wound closure was marginally extended in the negative-pressure wound therapy group (73 ± 45 days vs 64 ± 49 days; P = .045), this cohort demonstrated substantially more significant wound area reduction (48% ± 15 vs 25% ± 30; P < .001). Secondary outcome analysis revealed that negative-pressure wound therapy was associated with markedly reduced adverse events: wound infection (40 patients [20%] vs 95 patients [39%]; P < .001), ulcer recurrence (40 patients [20%] vs 113 patients [46%]; P < .001), and amputation rates (30 patients [15%] vs 132 patients [54%]; P < .001). Longitudinal assessment through Kaplan-Meier survival analysis demonstrated significantly greater wound closure probability and reduced complication risk in the negative-pressure wound therapy group throughout the follow-up period (log-rank P < .001). Conclusion Negative-pressure wound therapy is significantly more effective than advanced moist wound therapy in treating diabetic foot ulcers, demonstrating superior outcomes in wound closure, infection control, and amputation prevention. This study highlights negative-pressure wound therapy as the preferred treatment option for complex diabetic foot ulcers, warranting further research into its long-term benefits and cost-effectiveness.

BACKGROUND:Lyme disease is a tick-borne zoonotic disease caused by Borrelia burgdorferi sensu lato and is prevalent in northeastern Asia, particularly in the forested area of Northeastern China. However, a lack of systematic data on the spatial distribution of B. burgdorferi in this region hinders the prediction of its transmission risk across the landscape. METHODS:To provide an updated overview and establish a comprehensive spatial distribution database, we conducted a systematic review of literature published between 2000 and 2022. We collected and compiled relevant data on B. burgdorferi in Northeastern China and its neighbouring regions, outlining its distribution in ticks, wild animals, livestock and humans. Spatial analysis was performed to identify spatial clusters of tick positivity and host infection rates. RESULTS:From a total of 1823 literature, we selected 110 references to compile 626 detection records of B. burgdorferi, including 288 in ticks, 109 in wildlife, 111 in livestock and domestic animals and 100 in humans. The average detection rate of B. burgdorferi in ticks was approximately 20%, with wildlife, livestock and domestic animal host positivity rates below 50% and human seroprevalence rates varying from 0.94% to 44.18%. CONCLUSIONS:The study identified the presence of 17 tick species and ten genotypes of B. burgdorferi in the region, indicating a broad distribution. Notably, B. burgdorferi exhibited notable clustering, particularly in the central and eastern areas of Jilin Province, warranting further investigation.

Objective: This study aimed to evaluate the effectiveness of podiatrists in preventing diabetic foot ulcers (DFUs) in China. Method: The study was a prospective investigation. A total of 300 patients were enrolled from May 2016 to May 2018 in Handan Central Hospital, China. All patients who participated in this study had been diagnosed with type 2 diabetes, according to the International Classification of Diseases (ICD-10). All participants underwent our survey, which included basic patient data and information about DFUs. The patients were followed for one year, during which time they received appropriate intervention from podiatrists, including lifestyle guidance, callus resection, tinea grinding and ingrown nail correction. At the end of the year all the patients were surveyed again. The data before and after the year were statistically compared. Results: The results showed that the incidence of DFUs in patients with diabetes was significantly decreased after one year of intervention from podiatrists (20.7% versus 6.7%, p<0.001). Additionally, there was a negative correlation between the number of intervention visits and the number of DFU occurrences (Spearman correlation coefficient: –0.496, p<0.001). Furthermore, we found that 68 patients with a history of DFUs or amputation had an obviously reduced incidence of DFUs after intervention by a podiatrist (89.7% versus 27.9%, p<0.001). We also investigated other foot risk factors in all participants, such as limb neuropathy (76.3%), lower extremity vascular disease (65.7%) and foot paralysis (43.7%). Conclusion: The results of this study help in understanding the situation of patients with diabetes in China and to prove that standardised podiatrist intervention has an important role in inhibiting the occurrence and development of DFUs.

目的 从临床视角了解住院病人的健康素养状况及其影响因素,为改善病人健康素养提供依据和建议.方法 采用分层整群抽样方法,调查全国7个省市、77家综合医院的8238例住院病人.临床健康素养包括病情表述的难度和正确服药的难度;影响因素包括结构因素(性别、年龄、文化程度、婚姻状况、经济状况以及地域分布)和调节因素(家庭成员支持、亲属中从事医护人员的数量和最近三年的住院次数).结果 调查对象病情表述难度"较多/很多"的比例,男性占17.7％,女性占20.6％;正确服药难度"较多/很多"的比例,男性占12.4％,女性占11.6％.Logistic回归分析结果显示,相对大学及以上文化程度的患者而言,小学及以下文化程度的患者在病情表述和正确服药方面的难度均多(OR=1.44,95％CI:1.16～1.80;OR正确服药=2.07,95％CI:1.57～2.73);相对经济状况好的患者而言,经济状况差的患者在病情表述和正确服药方面的难度均多(OR=2.14,95％CI:1.76～2.61;OR正确服药=2.05,95％CI:1.62～2.59);相对住院次数3次及以上的患者,没有住过院的患者对病情表述的难度小(OR=0.66,95％CI:0.56～0.78).结论 病人病情表述上的困难多于正确服药上的困难,影响因素中结构因素(特别是文化程度和经济状况)的作用可能比调节因素(特别是最近三年住院次数)的作用更为重要.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">《国际疾病分类》第10次修订本（ICD-10）与《心理障碍诊断与统计手册》第5版（DSM-5）对烟草依赖基本特征界定的一致性,不仅有助于临床诊断标准的一致性,而且也有助于疾病流行病学调查测量的一致性,特别是在测量维度与指标选择方面。采用Fagerstrom尼古丁依赖检测量表（FTND）与烟草自制力量表（AUTOS）的组合作为烟草依赖流行病学调查的测量工具,在理论上与ICD-10和DSM-5烟草依赖的基本特征具有较好的逻辑一致性;在实践上,特别是在烟草依赖的分型与分级的分布状况及其决定因素的关系上,有可能为其相应的防治措施提供了更为深入的精准的证据。</span>

基于烟草使用紊乱和烟草断供症的临床诊断,即除行为类症状外,均包括生理、心理类症状和社会类症状,其中社会类症状的范围已从个人(个体)转化为他人(群体),本文籍此推导出人群烟草防治中的生理、心理与社会的并列关系以及病因与预防、症状与诊断、治疗与预后的递进关系,并提出现有的防治策略需与之融合.从预防角度,将“吸烟有害健康”改为“吸烟有害您的健康,更有害别人的健康”,可更直接、更准确地把吸烟从个体的卫生问题转化为群体的卫生问题;对治疗而言,应针对症状的多维度,特别是社会类症状进行钝化处理,如除专门的精神病医疗机构外,将其治疗融入综合医院的呼吸科或神经内科可能更加有利于改善其社会类症状及预后.

目的:探讨在基层医院建立糖尿病足工作室的工作模式,以提高糖尿病足防治水平.方法:成立糖尿病足工作室,围绕糖尿病足健康教育、筛查、预防、管理四大职能开展工作.结果:糖尿病足工作室门诊量由2015年的651人次上升到2018年的2688人次,2016、2017、2018年门诊量年增长率分别为64.98％、62.38％ 和54.13％;药占比由2015年的2.24％ 下降到2018年的1.33％;科室业务收入增加.结论:建立糖尿病足工作室具有较好的社会效益和经济效益.

目的:探讨足病师干预对糖尿病足溃疡发生的影响.方法:对2016年至2016年1月-2018年1月河北省邯郸市中心医院内分泌科收治的300例糖尿病患者进行观察,评估患者的血糖、生活方式,有无下肢血管、神经病变及鸡眼、胼胝、嵌甲、水泡等情况,由足病师对其进行生活方式指导、胼胝病变切除、甲癣磨削、嵌甲微力矫正和风险分级.观察足病师干预前及干预后1年糖尿病足溃疡发生情况.结果:足病师参与糖尿病足溃疡的预防和治疗1年后,足溃疡发生率(6.7％,20例)明显低于足病师干预前(20.7％,62例;P<0.001);糖尿病足溃疡风险分级为3级的患者在足病师干预1年后足溃疡发生率明显降低(89.7％ 比27.9％).结论:足病师干预可以明显降低糖尿病足溃疡的发生率;足溃疡发生率降低可能与对风险分级的干预管理有关.

Objectives To measure the burnout of doctors affiliated with western medicine (WM) and traditional Chinese medicine (TCM) hospitals and to evaluate its relationships with organisational and patient factors.Design A national cross-sectional study in China.Setting By convenience sampling, this study was conducted in 64 general hospitals from six provinces and Beijing between July 2014 and April 2015. There were a total of 2576 eligible participants, including 1766 WM doctors and 810 TCM doctors in this study.Primary outcome measures Burnout symptoms of emotional exhaustion, job involvement and personal accomplishment were measured.Results In total, 73.6% of doctors reported emotional exhaustion, the core component of burnout. In multivariable models, emotional exhaustion was significantly associated with organisational factors, including salary fairness [WM: odds ratio (OR)=2.36, 95% confidence interval (CI): 1.80 to 3.09; TCM: OR=1.59, 95% CI: 1.08 to 2.33], participation in organisational decision-making (WM: OR=1.58, 95% CI: 1.21 to 2.08; TCM: OR=1.84, 95% CI: 1.23 to 2.74), professional value (WM: OR=1.74, 95% CI: 1.35 to 2.25), frequency of participation in full-time training (TCM: OR=1.48, 95% CI: 1.01 to 2.16) and frequency of participation in clinical meetings (WM: OR=1.53, 95% CI: 1.11 to 2.10; TCM: OR=2.48, 95% CI: 1.57 to 3.92). Patient factors are also associated with burnout among both WM and TCM doctors, including respect (WM: OR=1.73, 95% CI: 1.31 to 2.28; TCM: OR=1.65, 95% CI: 1.10 to 2.45) and unreasonable demands (WM: OR=2.31, 95% CI: 1.68 to 3.20; TCM: OR=3.44, 95% CI: 2.15 to 5.49). Moreover, job involvement and personal accomplishment among both WM and TCM doctors were significantly associated with organisational and patient factors.Conclusions Our results suggest that improving organisational management and patient behaviours may be beneficial to reduce doctors’ burnout. Our findings require further validation in different organisational settings.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:从实证的角度分析住院患者的就医责任意识及其影响因素,以期为相关的管理政策提供依据和建议。方法:采用横断面设计,样本来自全国7个省/直辖市的64家三级综合医院的住院患者（n=7225）,自变量是对医护人员的尊重与信任、最近三年住院次数及家属中从事医护工作的人数等,控制变量为社会人口学指标。结果:总体上,调查对象报告的对医院秩序的责任意识"不知道、无、很小、较小"的占20. 77%;多因素分析结果显示:对病人遵循医院秩序的责任意识具有正向影响的是对医护人员的尊重与信任,有负向影响的是家属中从事医护人员的人数较多和最近三年住院次数较多。结论:患者重视其权利的同时,不应该忽视其相应的责任。尊重与信任医护人员对患者就医责任意识的影响提示卫生专业技术人员个人行为的作用及医院相关管理政策的重点对象。病人的住院次数及其家属中从事医护工作的人数对其责任意识的影响则提示病人教育的必要性。</span>

目的 了解内科住院患者生活质量的现况及病房管理相关因素对其的影响,为相关政策的制定提供依据和建议.方法 2014年7月—2015年4月,采用分层整群抽样方法抽取全国7个省/直辖市的77家综合医院的4130例内科住院患者进行调查研究.调查问卷为自行设计,主要包括基础问卷(人口学特征、健康相关行为和家庭因素、病房管理相关因素)和欧洲五维度健康量表(EQ-5D,包括移动性、自我照顾、日常活动、疼痛/不适、焦虑/抑郁5个维度),以EQ-5D评价患者的生活质量.分析内科住院患者的生活质量及病房管理相关因素对其的影响.结果 在内科住院患者EQ-5D的5个维度中,"有点困难/很困难"所占比例由高到低分别是焦虑/抑郁(61.6％)、疼痛/不适(56.7％)、日常活动(43.7％)、移动性(32.5％)和自我照顾(28.0％).多因素Logistic回归分析结果显示,配偶的支持/帮助是内科住院患者移动性、日常活动、焦虑/抑郁的影响因素(P<0.05);父母的支持/帮助是内科住院患者疼痛/不适的影响因素(P<0.05);子女的支持/帮助是内科住院患者日常活动的影响因素(P<0.05);兄弟姐妹的支持/帮助是内科住院患者自我照顾、日常活动的影响因素(P<0.05);病房整洁程度是内科住院患者移动性、自我照顾、日常活动、疼痛/不适的影响因素(P<0.05);来病房看望的家人/亲戚人数是内科住院患者移动性、自我照顾、日常活动、焦虑/抑郁的影响因素(P<0.05);来病房看望的同事/朋友人数是内科住院患者自我照顾、日常活动的影响因素(P<0.05).结论 内科住院患者生活质量中最严重的问题是焦虑/抑郁.从医院管理角度来看,改善内科住院患者生活质量应重视病房的整洁,并适当减少来病房看望的家人/亲戚、朋友/同事人数.

Objective To analyze the influencing factors for inpatients'evaluation of the cleanliness and quietness of the ward environment,in order to provide evidence and suggestions for related management policy.Methods By stratified cluster sampling method,8238 cases from 77 hospitals across the country were selected and investigated by using demographic scale,hospital organization related factors questionnaire,ward environment evaluation scale, EQ-5D and Chinese version of perceived stress scale.Results The percentage of respondents who rated the ward's quietness as"good/perfect"was 57.2%,and the percentage of respondents who rated the ward's cleanli-ness as"good/perfect"was 68.8%.Logistic regression analysis result showed that the organization-related factors(levels and categories of the hospitals)and personal factors(age,marital status andfrequency of hospitalization in the past three years)had significant effect on the inpatients'evaluation of cleanliness(all P<0.05).Personal factors(educational background,stress,and anxiety/depression)has significant effect on the evaluation of quietness(all P<0.05).Conclusions Ward's cleanliness might be influenced by or-ganization-related factors more;and its quietness is influenced more by personal factors.

Objective To retrospectively analyze the healing time and hospitalization costs of different TEXAS grades and stages patients and provide evidence for effective treatment.Methods The data of 147 patients with diabetic foot ulcer discharged in Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology from May 1,2015 to April 30,2016 were collected and screened out according to the inclusion and exclusion criteria.According to the classification of TEXAS university,patients with diabetic foot ulcer were grouped,TEXAS university grade 1 group (n =21):superficial ulcer;TEXAS university grade 2 group (n =31):ulcer up to the tendon;TEXAS university grade 3 group (n =95):ulcer involved bone and joint.The ulcer healing time and hospitalization costs of 3 groups of patients with diabetic foot ulcer were compared.Data were analyzed with the Kruskal-Wallis test.Results Among the 147 patients according to the grades of TEXAS university,the healing time of grade 1,2 and 3 patients were 12,22 and 33 days and the hospitalization casts were 13 199.20,19 572.81,32 101.30 yuan,and the healing time and hospitalization casts of different TEXAS university grades patients had statistically significant differences (F =24.19,24.04,with P values below 0.05).Conclusion The ulcer healing time and hospitalization costs in patients with diabetic foot ulcer were positively correlated with the grades of TEXAS university.

目的:了解患者对健康危险因素的总体感知及其影响因素.方法:采用分层整群抽样的方法,并根据WHO健康社会决定因素框架,从结构因素和调节因素的角度来分析对其的影响.结果:调查对象感知的源自生活的健康相关危险因素危害“较大/很大”所占比例(27.1％)高于源自工作的相应比例(21.7％).Logistic回归分析结果显示,结构因素中有显著性意义的主要是文化程度和经济状况,小学及以下文化程度的调查对象感知到的危险因素的危害更小(OR源自生活=0.64,95％ CI:O.54-0.76;OR源自工作=0.75,95％ CI:O.63-0.89);经济状况较差/很差的患者其危险因素的危害感知更大(OR源自生活=1.54,95％ CI:1.31-1.81;OR源自工作=1.72,95％ CI:1.47-2.01);调节因素对两个来源的危险因素的影响没有显著性意义.结论:源自生活的健康危险因素控制可能需要借鉴源自工作的健康危险因素控制的相关措施(即政策法规及相应的组织机构),结构因素和调节因素的影响则揭示健康危险因素的控制可能更需要依靠社会经济发展.

Objectives To evaluate patients' sense of responsibility to healthcare providers and to determine its predictors using on a national sample in China. Methods We conducted a national cross-sectional survey in China with a stratified cluster sample of patients treated in 77 hospitals between July 2014 and April 2015. Patients' sense of responsibility to healthcare providers was measured with four questions assessing patients' perceptions regarding their responsibilities to respect doctors, respect nurses, coordinate with health professionals, and comply with hospital rules. Predictors included patient socio-demographic characteristics and their past hospitalization experience. Results Small proportions of respondents reported that they perceived having no responsibility to respect doctors (8.9%), respect nurses (7.9%), comply with hospital rules (6.7%), or coordinate with health professionals (6.3%). Multivariate regression analyses showed that the strongest predictor of patients' sense of responsibility to healthcare providers was patinets' trust in health professionals, followed by patients' education level. Familiarity with healthcare professionals and past hospitalization frequency were inversely associated with patients' sense of responsibility to healthcare providers. Conclusions Although only a small proportion of the patients reported feeling no or low sense of responsibility to healthcare providers, the lack of respect and collaboration from these patients can negatively affect patient-provider relationships. Healthcare administrators need to communicate clearly with the patients and the public about the role of patients and the limitations of medicine in order to instill a sense of patients' responsibility.

Objective:The aim of this paper is to explore the influence of physician's occupational risk cogni-tion on defensive medical behavior. Methods:Semi-structured interview was applied for data collection from in-serv-ice doctors. A grounded theory was used to analyze and develop the relationship between physicians'occupational risk cognition and defensive medical behavior. Results:This study shows that the cognition of various occupational risks may lead to a series of psychological effects on doctors,such as mental stress,anxiety and depression,professional i-dentity decrease,fear of adventure and innovation,job enthusiasm decrease and probability of malpractice increase. Adverse defensive medical behaviors, such as ordering more tests, treatments and consultations, selective treatment of patients,shirking responsibility through informed consent, and favorable defensive medical behaviors, such as to improve service attitude,being more cautious during work and to improve professional skills,should be in response to occupational risks. Conclusions:Physicians'occupational risk cognition is the primary motivation of defensive medical behavior,and the relationship between physicians'occupational risk cognition and defensive medical behavior may al-so be mutually causal and effect.

Objective To examine the job involvement in community-based hypertension management,the satisfac tion to the management process and its influencing factors among community health workers and to provide practical suggestions for the improvement of community-based hypertension management.Methods A total of 249 community health workers in 14 administrative regions of Wuhan municipality of Hubei province were randomly selected and surveyed with a self-designed questionnaire in January,2015.The data were analyzed with descriptive methods and logistic regression analysis.Results Of all the respondents,71.9％ considered that the process of community-based hypertension management met the basic quality requirement;40.2％ were satisfied to the implementation of community-based hypertension management;60.6％ regarded the treatment of community hypertension patients as their responsibilities,but only 17.3 ％,28.1％,and 21.3 ％ reported participation in nursing service,health records management,and information system maintenance related to community hypertension patients.The improvements in medical insurance support for patients with chronic diseases,the participation of patients in disease management,incentives for community health service,and financial support for community health staff were suggested by 67.1％,69.5％,71.9％,and 73.9％ of the respondents,respectively.Logistic regression analysis revealed that the community health workers with satisfactions to professional training,anti-hypertensive drugs available at community healthcare center,cooperation of patients and the quality of follow-up work were more likely to be satisfied to the implementation of community-based hypertension management.Conclusion The satisfaction to the implementation of community-based hypertension management is at a general level and mainly influenced by professional training,anti-hypertensive drags available at community healthcare center,coopera tion of patients and the quality of follow-up work among community health workers in Wuhan municipality.

目的 探讨联合检测超敏C反应蛋白(hs-CRP)、胱抑素C(Cys C)和同型半胱氨酸(Hcy)在预测糖尿病早期肾病中的价值.方法 检测113例单纯糖尿病组和98例糖尿病早期肾病组hs-CRP、Cys C、Hcy水平变化;以100例体检健康者为健康对照组进行分析.结果 糖尿病早期肾病组中的3项检测结果 均高于单纯糖尿病组和健康对照组,差异有统计学意义(P<0.05).糖尿病早期肾病组和单纯糖尿病组hs-CRP、Cys C、Hcy联合检测阳性率高于单项检测阳性率.结论 联合检测hs-CRP、Cys C、Hcy可以提高糖尿病肾病的早期诊断效率,对于糖尿病早期肾病早发现、早治疗具有积极意义.

Objectives To explore the method of constructing patients' satisfaction evaluation system by service encounter theory.Methods We used narrative inquiry method to collect the patients' experience information in Chinese Third Grade Class A hospitals and analyzed the data according to the service encounter theory.Results The service encounter at any stage of medical treatment process can become a potential factor affecting the patients' satisfaction,for example,it belongs to setting and procedure dimension that there is no enough seats available during waiting,doctor's indifferent attitude toward patients belongs to attendant and interaction dimensions,it belongs to setting and outcome dimensions that patients cannot get their clinical tests results on the same day,etc.Timely improving the weakness of service encounter can effectively increase the satisfaction of patients.Conclusions Various service touch points can provide the basis of constructing a reasonable and effective patients' satisfaction evaluation system.Narrative inquiry method proved effective and may be used as a tool to supplement questionnaire method,which can be used to collect information in exploratory research stage.

The house of quality is a core tool for quality function deployment(QFD),a way for identifying the relationship between customers′ demands and the product/services capabilities,and an important tool for the development and design of products/services living up to customer needs.Based on the current community-based chronic disease management(CCDM),we explored the new way for CCDM with the house of quality model under the guidance of QFD theory,with a view to providing a reference for the development of CCDM services that meet the needs of the community patients.